Recently, Massachusetts passed legislation that requires all pharmacies within the state to provide prescription drug lock boxes for sale to the public at their locations. On August 9, Massachusetts State Senate and House of Representatives passed Chapter 283 to the Acts of 2010: An Act Adding Safeguards to the Prescription Monitoring Program and Furthering Substance Abuse Education and Prevention. The legislation is the first of its kind not just for the state of Massachusetts, but the entire U.S. The bill was sponsored by Governor Deval Patrick, Senator Steven Tolman, and the Massachusetts Pharmacists Association. Section 11(b) of the legislation states that all pharmacies that dispense Schedule II, III, IV, or V prescription drugs are required to make purchasable prescription drug lock boxes readily available to consumers in order to encourage the public’s safety efforts when handling over-the-counter and prescription medications.

Prescription drug lock boxes are safe and secure locking mechanisms that cannot be tampered with without extreme force and can only be opened through its combination lock. A combination lock ensures that only the prescribed patient will have access to their prescription medications as intended, and keeps these prescription drugs from falling into the wrong hands, particularly children. Most retailed prescription lock boxes are designed to hold up to four prescription bottles and can fit within the average medicine cabinet.

Prescription drug abuse has become a national epidemic in recent years, with an alarming rate of abuse among adolescents and older adults alike. On June 3, the Center for Disease Control and Prevention (CDC) reported that 20.2% of American teenagers (1 in 5) admit to having illicitly taken a prescription medication one or more times in their lifetime. Furthermore, the Substance Abuse and Mental Health Services Administration (SAMHSA) reports that 55.9% of prescription drug treatment admissions had illicitly obtained prescription medications from a friend or family member. Pain relievers, tranquilizers, stimulants, and sedatives are all highly potent drugs that can be just as toxic as street drugs when misused.

Teenagers who abuse pharmaceuticals most often obtain the drugs from their own parents’ medicine cabinets. Some teenagers may bring collections of prescription drugs to parties known as ‘pharm parties’ where multiple prescription drugs are shared among peers and often mixed with other substances such as alcohol, marijuana, or even cocaine. SAMHSA reports that the number of emergency room visits related to prescription pain relievers rose from an estimated 144,644 in 2004 to 305,885 in 2008—an increase of 111%. The abuse of opioid pain reliever medications has caused more overdose deaths in the U.S. than heroin and cocaine combined.

Even though pharmaceuticals are intended to help treat illness or alleviate pain, they are often misused for recreational purposes. Many Americans are unaware of pharmaceutical drugs’ potential for abuse, dependency, addiction, and overdose. The prevalence of prescription drug abuse has now become parallel with illicit substance abuse across the nation, affecting Americans of all regions and demographics. Prescription drug lock boxes are an effective tool for combating prescription drug abuse, and puts control right in the hands of parents to help keep their households safe. By mandating the sale of lock boxes, Massachusetts pharmacies are helping residents understand the dangers involved in handling controlled substances.

Source: PR Newswire, New Law Requires Pharmacies in Massachusetts to Carry Rx Lock Boxes, August 18, 2010

Established in 2007 in part by a $150,000 grant from the U.S. Environmental Protection Agency’s Aging Initiative, Maine’s Center on Aging has run a successful state drug mail-back pilot program. Maine’s mail-back program involves prepaid mailing envelopes for consumers in which they can return their unused medications to a central collection location that is owned by the state’s Drug Enforcement Agency. The prepaid envelopes are made available through physicians’ offices, pharmacies, or post offices. The mail-back program ensures the safe disposal of unused medications to authorities who then sort and incinerate the waste. Since the program’s inception, approximately 3,926 envelopes have been returned that contained a total of 2,300 pounds of drugs. Individuals who have participated in the simplistic mail-back program have utilized 42% of the available envelopes distributed throughout public resources.

Prescription drugs—like painkillers (opioids), benzodiazepines, antidepressants, and antipsychotics—are causing more overdoses and more emergency department visits than any other drug of abuse across several states due to recent surges in prescription drug diversion. Unlike illicit substances that are being sold on the street, Americans of all ages are mostly obtaining prescription drugs from friends or family members, either for free or at a price, for their intentional misuse. Pill mills are churning out pain relieving medications daily, and addicts and drug dealers alike are willing to cross state lines to get their hands on the drugs. Other addicts partake in ‘doctor shopping’ by visiting several doctors and pharmacies to gain multiple prescriptions for drugs like OxyContin, Vicodin, or Percocet—or even resort to identity theft or robbery to continue feeding their habit.

Since 2007, several states including Maine began initiating state legislation to manage the return of unused prescription drugs by implementing drug mail-back programs. Not only does the proper disposal of unused medications help the environment by avoiding drug waste from entering water treatment facilities or landfills, but it helps to prevent drugs from falling into the wrong hands. Too often, teenagers are confiscating prescription pain medications right from their parents’ medicine cabinets for recreational use, which can lead to severe consequences. These legal drugs can be stolen from patients and resold on the streets; in the case of prescription drug overdose death, the source of the prescription drugs is held accountable for the drug-induced fatality. The problem of prescription drug abuse is far-reaching, but can also be prevented with community involvement and intervention support.

After the Maine’s legislature acknowledged the success of its pilot drug mail-back program in early July 2010, the state has approved extended funding of the program to continue it for another two years. Besides Maine, states like Iowa, Oregon, Wisconsin, Pennsylvania, Virginia, California, Arkansas, Colorado, Hawaii, New York, and Tennessee have all adopted a form of consumer drug take-back programs or drug return programs with nursing homes and mental health clinics. The new model drug mail-back program is one method of alleviating prescription drug abuse that has exploded into a national health problem within the past decade. Now, advocates from Maine’s health community are urging Congress to adopt Maine’s pilot drug mail-back program for a national platform. Health professionals are citing the success of the Maine program as an effective method of preventing drug diversion and related health consequences, costs, and economic hazards.

Sources: The Portland Press Herald, David Hench, State gets a partner in fighting pill abuse, July 24, 2010

Enviro.BLR.com, Drug Mailback Program Effective, July 1, 2010

On his night shift in a busy emergency room, Dr. Jacob Khushigian inevitably finds a few patients more likely to be hunting for drugs than medical attention.

The guy who claims he has severe abdominal pain doesn’t grimace when sitting up. A woman who recently moved to the area fails to disclose she sees a doctor elsewhere. An ambulance patient complaining of a sore leg and back doesn’t reveal she was turned away by another hospital.

There was a time Khushigian’s hunches took weeks to confirm and required phoning or faxing the attorney general’s office to obtain a patient’s prescription drug information. Nowadays, a computer helps him catch cheaters. But it can only reach so far.

While a state online drug database went into effect last year to thwart addicts who bounce from doctor to doctor to feed a habit or make a small fortune peddling meds, there’s now a push to extend it beyond state lines to snare so-called doctor shoppers and curb drug abuse.

"The whole purpose of this is to have states communicating with one another," said Dr. Laxmaiah Manchikanti, chief
Doctors can be hamstrung in making critical decisions about prescribing painkillers if they aren’t able to find out if patients filled prescriptions elsewhere.

A nationwide network might have helped Michael Jackson’s doctor better monitor the medication he was receiving from multiple doctors.

Dr. Conrad Murray, who was recently charged with involuntary manslaughter in the singer’s death, told police Jackson gave few details when Murray repeatedly asked about Jackson’s medications, according to an affidavit. The Los Angeles County coroner said Jackson was killed by a mix of a powerful anesthetic and a sedative.

Police have searched for information in three states to see if Jackson’s medical history played a role in his June death.

Jackson’s death and those of other celebrities such as former Playboy Playmate Anna Nicole Smith and actor Corey Haim highlight the dangers of prescription drug abuse. More U.S. teens used prescription drugs over any other illicit drug except marijuana, the Office of National Drug Control Policy reported.

Forty states have passed legislation to allow prescription drug monitoring programs, but only 34 are operating.

Under the National All Schedules Prescription Electronic Reporting Act signed by President Bush in 2005, more than $50 million has been appropriated to states for programs where doctors and other authorized users, such as police in some cases, can access patient records.

The law aims to have a coordinated national system, but there are no estimates what that would cost and a majority of the federal money hasn’t been allocated.

Joanee Quirk, who runs Nevada’s prescription monitoring program, said having access to other state databases would help stop those from Southern California or Hawaii who come to Las Vegas or Reno to score Vicodin or OxyContin.

Nevada’s four-year-old program has grown to more than 225,000 patient requests in 2009 from about 155,000 in 2008.

Most prescription monitoring programs are voluntary, but Nevada requires doctors to check a patient’s drug history during a first visit.

"If we took it away the practitioners would have a revolution," Quirk said. "It’s almost like getting a lab test, where the doctors are trying to figure out what is wrong with this person and whether they are trying to get drugs legally."

Some privacy groups are concerned databases could invade patients’ privacy. Virginia’s database was hacked into in April 2009 and millions of electronic records were stolen by a thief still at large.

"There is a significant intrusion into the lives of individuals who are taking these medications legitimately," said Pam Dixon of World Privacy Forum, a nonprofit public interest research group. "There needs to be more restrictions about who can access this information."

The response to having secure, online access to patient records has been overwhelming so far in California. More than 2,300 doctors, pharmacists, physician assistants and registered nurses have used the Web site since September to access more than 134,000 patient reports. The state had averaged about 60,000 requests annually when they received requests by phone or fax.
Katherine Ellis, who runs the database of about 100 million prescriptions, said emergency room doctors would benefit most from a multistate system.

"If there was a way for ER doctors to sign on as they are triaging that patient and see if that person has been doctor shopping, then they may not elect to give them the controlled substances," she said.

Khushigian, 52, who works at Kaweah Delta District Hospital in Visalia in the Central Valley, is glad he no longer has to rely solely on his gut every night. He uses the database two or three times a night to shut down potential abusers.

"When they get caught, there isn’t much they can say," he said.

After receiving treatment, nurses and other healthcare workers will be required to pay for clinical evaluations involving bi-weekly drug tests. After a worker tests negative for drugs, he or she will be allowed to return to work, according to the new rules from the California Department of Consumer Affairs.

During their first year back on the job, these workers will face 104 drug tests. A single relapse will result in immediate, though usually temporary, license suspension. State licensing boards will be required to publically identify nurses and healthcare workers who have an inactive license or are subject to increased supervision. They won’t be able to identify the workers as recovering drug addicts.

The new regulations come as a result of a news investigation earlier this year that found that nurses were allowed to treat patients and often continued to steal drugs while enrolled in a confidential rehabilitation program.

The Drug Enforcement Agency has more strictly been enforcing rules regarding the dispensing of pain-relieving drugs in nursing homes. For more information, visit www.dca.ca.gov.

"Even though they don’t fall under the Controlled Substance Act, prescriptions are, by definition, controlled substances," explained Dr. Steven Marcus, executive and medical director of the New Jersey Poison Information & Education System (NJPIES).

"Prescriptions are given by a physician to a specific person for a limited time in a defined dose, and they can be very toxic if used in any other way than prescribed. No one would keep heroin and cocaine in the medicine cabinet, but inadvertently, homes are havens for drug abuse due to the increasing number of controlled prescription medications on hand in the average home,” Dr. Marcus said.

Parents, he explains, have been educated about the dangers of street drugs, but the more obvious risks associated with sedatives and stimulants in the home are being overlooked.

New studies, high-profile celebrity cases such as the recent deaths of Heath Ledger and Michael Jackson, and increased public education are alerting the public to the perils of prescription drugs, both as readily available controlled substances and as toxins, when overused or when combined with other prescriptions and unregulated OTC medications.

In her testimony before the U.S. Senate Judiciary Committee, Nora Valkow, director of the National Institute on Drug Abuse, noted that 7 of the top 11 drugs most commonly abused by high school seniors are either prescribed or purchased over the counter.

"Parents are not addressing the problem because they aren’t aware of it," noted Dr. Marcus.

A 2008 New Jersey study conducted by the Partnership for a Drug-Free New Jersey found that 44 percent of New Jersey parents knew little or nothing about the dangers of prescription drug abuse.

Teen abuse is only one of several concerns about home drug availability, according to NJPIES. Seniors are vulnerable because they are prescribed more medications, and increased availability plus mix-ups due to either poor vision or inadvertent combinations of medications put seniors at increased risk. Adults aged 40-49 account for half of all documented cases of prescription drug abuse, according to a study by Medco Health Solutions, Inc., in Franklin Lakes, N.J.

From January to April 2009, NJPIES received more than 90 calls for assistance with teens who had exposed themselves to medications in order to get high. The majority of these calls involved prescription and OTC medications.

"As with most public health issues, the key is prevention, and an easy way to prevent prescription drug abuse as well as mishaps with OTC medications is a simple lock," stated Dr. Marcus.

He advocates for medicine cabinet locks being required safety precautions in every home, similar to smoke and carbon monoxide detectors. He recognizes that most American homes have open medicine cabinets, but he strongly believes that the practice be re-evaluated in light of growing and disturbing information about unnecessary deaths and toxic incidences in the home.

Nationally, poison control centers have found that analgesics top the list, at 12.9 percent, as the most frequently reported toxic substance to which callers have been exposed. In comparison, stimulants and street drugs were cited in only 1.9 percent of reported cases.
70 percent of people who abuse prescription pain relievers say they got the drugs from friends or relatives.

Upward of nine million people are reported to use prescription medications for non-medical uses, and New Jersey is one of 16 states where the number of deaths due to drugs is higher than the number of deaths from vehicular accidents.

On Nov. 14, New Jersey will become the first state in the nation to coordinate a statewide effort to rid homes of unwanted and unneeded drugs of all types. NJPIES, with its long history of efforts to educate the public about the dangers of drugs in the home, will supply educational material to more than 250 collection sites around the state.

"This call to action is an excellent reminder to residents to cleanse homes of potential medicinal toxins, but the effort should not stop there," noted Alicia Gambino, director of public education for NJPIES.

"This exciting effort is long overdue, and it should serve as a wake-up call for New Jersey residents to take aggressive actions to keep their families safe year-round."

At least 1.5 million preventable deaths occur each year as a result of prescription drug abuse, according to the Institute of Medicine, and the cost of these injuries and deaths is estimated at about $4 billion annually. Children are often the victims: One study found that between 2003 and 2006, more than 9,000 children were accidentally exposed to prescription drugs such as codeine and morphine.

As a result, the Food and Drug Administration wants to reduce the abuse and misuse of prescription drugs, saying that at least 50,000 hospitalizations a year could be prevented if people used greater care in dispensing and taking the drugs.

FDA commissioner Margaret A. Hamburg said the FDA intends to work with physicians, pharmacists, insurers, drug companies, patients, and parents to develop a list of specific problems and a strategy for addressing them. "When I first started looking at this, I was stunned at the scope of the problem," she said as she announced the new "Safe Use" program.

Some measures may call for voluntary action on the part of the drug industry and medical community, and some may require new FDA regulations, Hamburg added. Steps may include providing better information to consumers, improving the dispensing devices that accompany drugs, and urging caregivers and patients to follow the directions of the drug maker. The agency will also look for ways to reduce intentional misuse, drug abuse, and self-harm, Hamburg said.

"Simply putting out a warning label [on a medication] does not insure safe and effective use in the real world," said Janet Woodcock said, a physician who directs the FDA’s Center for Drug Evaluation and Research. "We can’t overlook this and say, ‘These guys are not using this right and that’s not our problem.’”

Statistics show that more than 6.2 million people age 12 and older abused prescription drugs in the last month. Only 4.7 percent of people 12 and older who abuse prescription drugs get them from a stranger, drug dealer, or the Internet. Fifty-six percent obtained the drug they most recently abused from friends or relatives

"We know that prescription drug abuse among kids starts with access to the family’s medicine cabinet," said Peggy Sapp, President and CEO of NFP. "With more than 4,000 children and young adults experimenting with prescription drugs every day, this day is intended as a wakeup call for all parents to take responsibility for what is happening in their home and lock up their prescription medications. Parents literally hold the key to their children’s drug-free future."

The second generation "Lock Your Meds" Day is part of the 24th annual Red Ribbon Week during October 23-31, the oldest and largest drug abuse prevention program in the United States. To help reach children and teens with the drug-free messages during this time, NFP reaches out to more than 91,000 schools across the country and encourages these schools and communities to unite and take a visible stand against drug abuse.

NFP urges parents and family members to take the following steps to prevent teen prescription drug abuse:

– Lock your prescription medication and prevent abuse or misuse by
securing the medication in your home.

– Take inventory of your current medications and periodically check that
nothing is missing.

– Educate yourself and your children about the most commonly abused types of prescription medications and communicate the dangers to your child regularly.

– Set clear rules and monitor behavior by expressing your disapproval of
using prescription drugs without a prescription.

– Properly dispose of old and unused medications.

To help parents take these steps and prevent prescription drug abuse in their homes, the campaign website (http://www.lockyourmeds.com) includes easy-to-use resources such as a home medicine inventory card and downloadable guidelines on how to properly dispose of prescription medicine.

Parents can take a stand against prescription drug abuse by signing an online pledge and sharing their message with friends and family.

For more information on teen prescription drug abuse, Red Ribbon Week or to download "Lock Your Meds" materials, please visit http://www.lockyourmeds.com or call 305-856-4886 or toll-free at 800-705-8997.

Mark Hobbs said this is his way of trying to fight prescription drug abuse. The family-owned pharmacy was robbed twice in 2007. "We have people with a real need for their medications," said Hobbs, whose family has run the pharmacy for more than 40 years. "And then there are people who are addicted to the stuff and desperate for it."

Kaustuv Basu of Florida Today writes that in 2007 and 2008, 199 people died from prescription drug abuse in Brevard, Florida. Prescription drug seizures by the Brevard County Sheriff’s Office went up by 87 percent in 2008 compared with the year before, from 2,895 doses to 5,406 doses.

Over the past 10 years, the euphoric effects of OxyContin have led to a significant increase in illicit usage. A single 80-milligram OxyContin pill can be sold on the street for as much as $50, which is "several, several times the original price," said Agent Doug Caskey of the Brevard County Sheriff’s Office.

Meanwhile, the state is stepping up its efforts to curb abuse of prescription drugs. In July, Florida became the 39th state to adopt prescription drug-monitoring laws. And next year pharmacists can start using an online system to detect prescription fraud and "doctor shopping,” which involves patients going from doctor to doctor to obtain multiple prescriptions.

Statewide, deaths from prescription drug abuse now far surpass illegal drug abuse, officials said. In 2007, Florida reported 989 deaths from illegal drugs. Prescription drugs killed 2,328 people in the same time.

Andrew Benard, chief of staff for the Florida Office of Drug Control in Tallahassee, said that the many reasons for the increase in prescription drug abuse include issues with health care licensure, a transient population, other states implementing prescription drug-monitoring programs, and a late start by Florida in establishing its own monitoring prescription abuse.

"We have been trying to pass this prescription drug-monitoring bill since 2001," Benard said. "I think lawmakers now understand the criticality of it with its role in reducing drug abuse and drug diversion.” He said a database to monitor pill abuse will be up and running by December 2010.

"It is a uniform database, which ensures the privacy and confidentiality of its information, that physicians and pharmacists can check," he said, adding that details of the system are still being worked out.

The illicit prescription drug trade can also be extremely violent. In Brevard County, pharmacies have been robbed, homes broken into, and people shot—all in the quest for prescription drugs like OxyContin and other powerful painkillers like Vicodin and Percocet.

In July, two men invaded a West Melbourne house and shot and killed one man while critically wounding his brother. The sheriff’s office described the incident as a "prescription drug robbery gone wrong."

Sheriff’s detectives investigating the incident said some of the participants were involved in an organized ring that would forge prescriptions, buy pills, and sell them in places as far away as Kentucky.

Cmdr. Doug Waller of the sheriff’s office said prescription abuse is a critical issue for everyone, from families to the medical community as a whole. "It affects every age group and every ethnicity," he said. "It starts at home, by preying on the family medicine cabinet," Waller said. "When that runs out, you go looking to friends and neighbors."

That, in turn, can lead to doctor shopping, which can eventually lead to prescription fraud or buying pills from illicit providers.

Waller said another thing that compounds the abuse problem is the fact that prescription drugs tend to be abused in their purest form, unlike illegal drugs, which are often diluted. People often snort prescription drugs after grinding them into a powder.

Increasing community awareness is an important aspect to fighting the problem. Last week, south Florida resident Karen Perry talked to Palm Bay parents about the dangers of prescription drug abuse. PREVENT of Brevard, a community organization committed to preventing substance abuse, was also represented.

Perry lost her 21-year-old son in 2003 to a drug overdose. The next year, she started a nonprofit organization called NOPE—Narcotics Overdose Prevention & Education—to help educate people with prescription drug abuse issues. NOPE now partners with law enforcement agencies across the state. "We try to share personal stories," Perry said. "This can happen to anyone."

Perry believes prescription drugs have become a gateway drug for the young. "Most parents are worried about their kids drinking or smoking pot," Perry said. "But the bigger danger might be lurking in the medicine cabinet within easy reach."

“The driving factor in kids using prescription drugs and then heroin is that they get sick when they stop,” said Dr. Alex Stalcup. “This is the new epidemic.” He also said that within two years of using heroin, people begin to inject the drug for quicker relief, which can lead to death, increases in crime rates, and occurrences of HIV and hepatitis.

Members of Nevada’s Meth Alliance were concerned by Dr. Stalcup’s words, as police and treatment providers are reporting a rise in heroin use.

Dr. Stalcup was asked to speak by members of Join Together Northern Nevada members, part of the meth task force, so they could get help in figuring out how to address the rise in youth prescription drug abuse before it becomes an epidemic. No statistics exist, but officials say they are seeing a rise.

Sgt. Mac Venzon of the regional Street Enforcement Team said heroin arrests have risen from about 1 to 2 percent of the caseload to about 15 percent. Most of the users are young, he said, with the sellers being organized and from Mexico.

The January death of a 15-year-old Reno boy who overdosed on two methadone pills prompted the alliance to investigate the issue. Austin Riley Jones’ parents said he took the pills at a party and likely had no idea of the drug’s fatal consequences.

The group’s public campaigning has been credited with helping reduce local meth use and associated problems.

Stalcup, a pediatrician and medical director of the New Leaf Treatment Center in Lafayette, California, said the Internet is fueling youth prescription drug abuse. He said the age-range of prescription drug addicts are between 15 and 24, many of whom had no previous risk to become addicted.

Increases in heroin users, Stalcup said, means there was a failure to intervene when they were abusing prescription medications. He said treating addicts when they are in jail with a highly effective drug called buprenorphine can help them get clean. He suggested rehab stints longer than 28 days, along with outpatient therapy and sober living.

“Absent intervention, there is no choice but the needle,” Stalcup aid. “Because there is no treatment for them to get off the prescriptions, their disease perpetuates. They need medical management to get through withdrawals, which is a horrible experience.”

“They say this happens to other people, not us. But this is us, and these are our kids,” Stalcup said, encouraging the meth alliance to tap into emergency rooms, health departments, and schools to gather data on youth drug abuse.